COVID-19 Data Management

Standard Operating Procedures

Ministry of Health
Ethiopia
INTRODUCTION
Ethiopia developed a National Deployment and Vaccination Plan for COVID-19 (NDVP) with the goal of
vaccinating 20% of the country's population, including health-care personnel, the highest-risk group,
other essential/frontline personnel, and the elderly aged 65 and up. As vaccine availability has increased
significantly, the necessity for target shifting has arisen, and it has been decided for all people aged 12
and higher. For COVID-19 immunization, the service delivery strategy employed is static (fixed post in
the health facility), outreach, and mobile sites.

Ethiopia adopted the WHO-recommended COVID-19 Vaccination data elements collecting and reporting,
to meet the enormous demand for data from national and subnational governments, the public, civil
society organizations, the media, and regional and global immunization partners. The District Health
Information System 2 (DHIS2) is being used in part as a national COVID vaccination data reporting
system. A Google sheet reporting system, on the other hand, has been implemented to collect and compile
daily COVID-19 campaign data at regional and National level.

The COVID-19 vaccination rollout is monitored at the community, health facility, Wereda and regional
levels through routine and periodic data generation and management. In view of this, a standard operating
procedure is required that outlines the specific processes of the data collection, collation, analysis, and use
as well as the data quality assurance processes related to COVID-19 vaccination data, from the point of
generation through the hierarchical levels of aggregation. This document provides the standard
procedures that are followed at the various stages of the data management chain. It is a living document
that is sufficiently flexible to meet the dynamic needs of the COVID-19 vaccination M&E system. The
purpose of this document is to provide guidelines for all implementers on the steps to take to ensure that
the required data are collected and are of the appropriate quality.

Objectives
The general objective of the SOP is to ensure that the information generated from the service delivery
points meets the characteristics of a good quality data. This means that complete data sets of sufficient
quality are available at all levels by the agreed timeline. The data should be analyzed using standardized
indicators, and all data users should be provided with appropriate and regular reports.

• Facilitate and standardize COVID-19 Vaccination data collection and reporting at all levels of service
delivery by providing guidance and standard operating procedures (SOPs) on the use of standard data
collection and reporting tools
• Enable data to be captured electronically at the wereda and health facility levels
• Outline the responsibilities of each level of the health system
• Provide guidelines on the data retrieval, updating and back-up processes

Target Audience
The SOP is designed primarily for health care workers who are responsible for the management,
implementation, and monitoring of COVID-19 Vaccine delivery at community, health facility, Wereda,
Zone, Regional and National level. It may also be useful for any partners who provide the required
support in the country.

COVID-19 Data Management SOP

Overview of the COVID-19 Vaccination reporting system and data flow
COVID-19 vaccination data is collected at service delivery points (Health centres, health posts, mobile
sites, outreach sites, hospitals, and clinics). A hard copy COVID-19 vaccination register is used to keep
track of individual data. The register contains the individual's basic information as well as vaccine
information. Health care providers tally reportable data elements in the COVID-19 tally sheet after each
individual vaccination. Each vaccination site will report a daily summary to the PHCU at the end of
each vaccination day. A compiled data will be reported to Wereda, and data will be submitted into
DHIS2 at the same time. Wereda health offices submit compiled data to Zonal health offices. Because
DHIS2 is not yet deployed in all facilities and weredas, a google sheet data reporting tool is being used
to report daily vaccination data at the regional level.

Data collection and Reporting

Principles
• Every vaccination given at any visit should be recorded/updated in the COVID-19 vaccination
register and COVID-19 vaccination card
• All vaccination given should be tallied based on the appropriate disaggregation (Age group,
Gender, Dose Schedule, and vaccine type)
• Service provider at vaccination site completes the information required by the register, tally
sheet and vaccine card as service is provided
• Service provider at vaccination site compiles daily vaccination data and report to the next level
• Record any AEFI reported in the AEFI reporting form

Tools

The following tools will be used to record and report COVID-19 vaccination data depending on the
levels of reporting.
1. COVID-19 Vaccination Register
2. COVID-19 Vaccination Tally sheet
3. COVID-19 Vaccination Card
4. COVID-19 Team Supervisor Daily Reporting Form
5. COVID-19 PHCU Daily Reporting Form
6. COVID-19 Wereda Daily Reporting Form
7. COVID-19 Zone Daily Reporting Form
8. COVID-19 Region Daily Reporting Form
9. DHIS2 tracker reporting system
10. COVID-19 AEFI reporting form
11. COVID-19 AEFI Investigation Form
12. COVID 19 AEFI Line List

COVID-19 Data Management SOP

 1. COVID-19 Vaccination Card

COVID-19 Vaccination Card

Who updates Health care workers completes the information required by the COVID-19 vaccination card as service
is provided
Where to Keep: The COVID-19 vaccination card should be kept by the individual
When to use Whenever the individual comes for vaccination to a vaccination site of any capacity –
facility/outreaches/mobile sites
Description
This is the individual’s vaccination record/certificate. It is kept by the individual and therefore is the only immunization
record that is found in the community. This card should be brought to the vaccination sites during each visit. The vaccination
card is important for many reasons:
• It serves as a reminder for the individual to return to the health facility/vaccination site for the next dose(s)
• It helps the health worker determine an individual’s vaccination status.
• Allows continuity of service when the person moves to another area
• During coverage surveys, the card is used to verify vaccination status of the individual
• It is important to generate electronic vaccine certificate (QR code)

Individuals should be reminded to keep the COVID-19 vaccination card in a safe place and to carry it to all vaccination
schedules (2nd dose or Booster)
How to use covid-19 vaccination card
The following steps will be used to complete the COVID-19 vaccination card
• For an individual visiting the vaccination site for the first time, health care workers will issue COVID-19 vaccination
card and fill the demographic data as well as vaccination information.
• For revisit client, health workers will update the vaccination status
The following information should be recorded in the COVID-19 vaccination card

ID.NO: - Write the individual ID Number. This should be the same with the ID number recorded in the COVID-19
vaccination register
Passport Number: - Write the passport number of the individual (if applicable)
Full Name: - Write the full name of the individual legibly
Age: - Write age in full years
Sex: - Write sex of the individual in full format (Female, Male)
Occupation: - Write the Occupation of the person
Region, Zone/Sub Cirty, Wereda, Kebelle, Village: - Write the residential region, zone/sub city, Wereda, kebelle, village,
of the individual. This can be cross referenced with the information in the individual ID

On the second page of the COVID-19 vaccination card record the following information

First Dose
• Vaccine type: - Write the full name of the vaccine type administered
• Batch Number: - Write the batch number of the vaccine administered legibly
• Date Vaccinated: - Write the date of vaccination legibly in DD-MM-YYYY format. Primarily use Ethiopian
calendar
• Next Vaccination Date: - Write the next vaccination date for subsequent doses (2nd dose or booster) in DD-MM-
YYYY format
Follow the same procedure for 2nd and booster doses

COVID-19 Data Management SOP

 2. COVID-19 Vaccination Register
COVID-19 Vaccination Register
Who updates Health care workers completes the information required by the COVID-19 Vaccination Register
as service is provided
Where to Keep: The COVID-19 Vaccination Register should always be kept at the vaccination facility
When to use Whenever there is vaccination session in the vaccination sites of any capacity and setup
– Health facility, mobile sites, outreaches, campaigns and other
Description
The COVID-19 Vaccination Register is a longitudinal register with each row covering full course of vaccination data for one
individual. The COVID-19 Vaccination Register assists health care providers in keeping track of the vaccinations they
provide to every individual.

The COVID-19 Vaccination register must be available at the service delivery point all the time to ensure that all information
and vaccinations are recorded. It is the service delivery point’s primary source of information on an individual vaccination
status and needed vaccinations. This information is particularly helpful if the individual attends for a follow-up visit without
their COVID-19 vaccination card
How to use COVID-19 Vaccination Register
• The facility should ensure availability of a revised version of COVID-19 Vaccination Register – contain all the
variables to be recorded to avoid lumping together of information by the service provider
• When HF staff go to outreach/ mobile immunization service, they need to carry the register
• All vaccination data should be recorded in the COVID-19 Vaccination Register as soon as the individual received
the first dose at the health facility or outreach sites
• For every new person (never vaccinated) create a new entry in the register and create a new COVID-19 vaccination
card
• Once registered in the COVID-19 Vaccination Register do not create a new entry in the register each time the
individual visits the facility for subsequent doses
• In subsequent visits locate the individual’s entry by Serial Number or ID number in the register and update data for
each dose provided
o If the COVID-19 vaccination card is not available, ask the individual the details of the first
immunization to locate his/her entry in the register
• For an individual who has come to your health facility for the first time but has received first dose in
another health facility, create a new entry in the register, ask for the COVID-19 vaccination card and mark
on the register that the individual has already vaccinated for first dose. Provide the second dose or Booster
Dose, record in the register and tally for reporting.

• DO NOT TALLY and REPORT VACCINATION GIVEN BY ANOTHER FACILITY

How to record information on the register
When an individual comes for the very first time, fill in all information in the register except the space provided
for vaccinations (The column for each dose should be completed after the vaccinations are provided)

• Region, Zone, Wereda, Kebele: - Write the respective region, zone, wereda, and Kebelle where COVID-19 Vaccine
canter is located
• Name of Vaccination Post: - Write the official name of the health facility, IDP (internally displaced people) &
Refugee camps where COVID-19 Vaccine centre is located
• S.N: - Write serial number starting from 001 in a consecutive order. This is a continuous number given once for
every individual registered in the COVID-19 vaccination register according to their order This will continue to the
last page of the register. The serial number should also be recorded in the individual COVID-19 vaccination card for
easy retrieval during the next vaccination schedule
• ID Number: - Write the person’s identification number (ID)

COVID-19 Data Management SOP

 o There should be a unique identification number (serial number or ID number) on the register for each
individual and use the same number on the COVID-19 vaccination card. This way, for the next vaccination,
it will be very easy to locate the individual’s entry on the register

• Full Name: - Write the names of the person’s father & grand father
• Age: - Write the person’s age in full years
• Sex: - Write the person’s sex
• Occupation: - Write the occupation of the person
• Co-morbidity: - Write the person’s disease code as indicated at the bottom of the registration book
• Pregnant/Lactating: - Ask if she is pregnant or lactating write the status as "pregnant " or "Lactating" if not leave
it blank
• Others: - Write the codes indicated at the bottom of the registration book

Address of the person

Village/Gote: - Write the village/Gote where the person lives

House Number: - Write the house number of the home where a person lives

Date of Vaccination

Vaccine Name: -Write the full name of COVID-19 Vaccine for each dose
(DD/MM/YY): - Write the date, month and year for each dose provided with full date format DD-MM-YY
• Doses administered are recorded legibly in the vaccination register immediately after administration of the vaccine
(and not before or much later)

Batch Number: - Write the Batch number of the booster dose of the vaccine
Phone Number: - Write the person’s mobile phone number

COVID-19 Data Management SOP

 3. COVID-19 Vaccination Tally Sheet
COVID-19 Vaccination Tally Sheet
Who updates Health care workers tally every single vaccination as service is provided. If this instruction is not
observed, there is a high risk that vaccines that have been administered will be miscounted because
of the complexity of counting administered vaccines for a specific time from a longitudinal register
Where to Keep: The COVID-19 vaccination tally sheet should always be filed and kept at the vaccination site
When to use Whenever there is vaccination session in the vaccination site of any capacity-facility/outreach/mobile
site.
Description
Tally sheets are forms that are marked every time a health worker administers a dose. They are used to collate and complete
reports
• The main body of tally sheet has dose number, age, and gender disaggregation for each vaccine type.
• Use a separate tally sheet for each day of vaccination and category
• Tally sheets should be used for all sessions whether fixed, outreach or mobile. When HF staff go to outreach/ mobile
immunization service, they need to carry a tally sheet
• All vaccinators in a health facility should use the same type of tally marks (/) to make it easier to count the totals
Doses administered should be tallied immediately after administration (and not before or much later)
How to use COVID-19 Vaccination Tally Sheet
The facility should ensure availability of a revised version of COVID-19 Vaccination tally sheet for each planned
vaccination session

In first upper part of the tally sheet

• write the name of the region, zone, Wereda, Kebelle and health institution
• Write the date of vaccination in DD-MM-YYYY format
• Type of COVID-19 vaccine given: - Write the full name of the vaccine type in the tally sheet

For each vaccination you perform, strike the printed zero vertically at the correct line on the tally sheet next to the dose you
have just given (1st dose, 2nd dose or Booster dose) according to age group and sex of the individual (12-17 years, 18-64
years, >=65 years for both Female and Male), Tally mix and match doses as a second dose.

After completing each tally sheet for the day, the total number of tallied should cumulate at the end of each age/Gender
category and in the last column of each sheet by gender. This gives the total number of vaccinations given with each dose for
the day

At the end of the tally sheet, write

• Vaccine type: - Write the full name of the vaccine type administered
• Batch Number: - Write the batch number of the vaccine administered legibly
• Vials Received: - Write the number of vials Received for the vaccination session
• Vials Returned: - Write the number of vials returned from the vaccination session
• Vials Damaged: - Write the number of vials damaged (if any)
• Wastage Rate: - Calculate wastage rate and write in the space provided

DO NOT TALLY and REPORT VACCINATION

GIVEN BY ANOTHER FACILITY

COVID-19 Data Management SOP

 4. COVID-19 Vaccination Daily Reporting Forms
COVID-19 Vaccination Daily Reporting Forms
Who updates Team supervisors, PHCU coordinator, Wereda Coordinator, Zonal Coordinator and regional
Coordinator compiles, check, and review data, then forward one copy to their designated
administrative office according to their level.
Where to Keep: The COVID-19 vaccination daily reporting forms should always be kept at the vaccination sites and
each administrative level health offices.
When to use Daily in the vaccination sites, PHCU, Wereda, Zone and Region
Description
The daily reporting form is the reporting format used to collate and report all vaccinations given at the vaccination site. At
the PHCU level this is the primary reporting tool for summarizing all vaccinations provided from all vaccination sites
(outreaches/mobile clinics and Health facilities). It is completed by summarizing the data from tally sheets for a particular
day.

This report is very important and must be carefully done at each level
• It is this report that is aggregated at regional and national level
• It is the source document for determining the performance of the Wereda, zone, region, and the country.

How to use COVID-19 Vaccination Daily Reporting Forms

The daily reporting form has two sections
• Fill in the vaccination date and name of the health facility, Wereda, Zone and Region at the top of the reporting form
• One reporting form is for one vaccine type
Section A- Number Vaccinated by age Group
It is completed by summarizing the data from the daily tally sheets for a particular day. Each day when you finish your
vaccination session
• Fill Name of the vaccination post or PHCU or Wereda or Zone according to your level of reporting
• Enter the target population of the vaccination post or PHCU or Wereda or Zone according to your level of reporting
• Count the number of vaccinations recorded on the tally sheet for each age group and gender (12-17 M/F, 18-64 M/F,
65+ M/F) and enter the daily totals on the reporting form
• Make sure that you enter the totals from the COVID-19 vaccination tally sheet in the correct column
• When you have finished the entries for each age group and gender, sum up each column, and enter the totals in the
last part of the column written “total vaccinated”

Section B: Vaccine logistics

• It is found in the right part of the reporting form, and it contain information about vaccine Logistics (Vials received,
vials used, vials damaged and wastage rate.
o Vials Received: - Fill the number of vials received for the day by the vaccination site
o Vials Used: - Fill the number of vials used in the day
o Vials Damaged: - Fill if there are any damaged vials in the vaccination site
o Wastage Rate: - Calculate and put the wastage rate for the day in the vaccination site

Reporting on any adverse events following immunization (AEFI)

If there have been any adverse events following immunization during the session, the health care provider should compile
from the tally sheet accordingly. But, if there is any serious adverse event, it should be reported immediately.

After completing both sections of the form, Send the reporting form in the same day to the next administrative
level. Remember to put the date and your name in the space provided at the bottom.
*NB. The health worker should ensure that all fields in the daily reporting form are filled appropriately before
sending to the next level.

COVID-19 Data Management SOP

 5. DHIS2 Reporting and data visualization

DHIS2 reporting system

Who updates PHCU/Wereda Health Information Technician or EPI focal person who is trained on COVID-19
vaccination data reporting using DHIS2.
Where to Keep: The DHIS2 COVID-19 vaccination data reporting system is a web-based system designed to collect
an aggregate data based on the daily reporting format. The data should be kept at the health facility
or Wereda health office
When to use Daily in the PHCU or Wereda health office where the DHIS2 system is implemented
Description
District Health Information System (DHIS2) is implemented as a COVID-19 vaccination aggregate reporting
system to collect, collate, and analyze COVID-19 vaccination data at all levels of the system. Data will be entered
every day following the vaccination session. The system is also used to generate digital vaccination certificates for
travelers.

This report is very important and must be carefully done at each level
• DHIS2 is the official health information system of the country
• It is accessible at all levels of the health system for program planning and monitoring
• It is this report that is aggregated at regional and national level
• It is the source document for determining the performance of the Wereda, zone, region, and the country.

ALL COVID-19 VACCINATION DATA SHOULD BE CAPTURED IN THE DHIS2 SYSTEM

How to use COVID-19 Vaccination Daily Reporting Forms

The DHIS2 system has the following components

Event Capture: - This is where the COVID-19 vaccination data is entered. Event Capture lets you capture and submit the
daily aggregate reports of COVID vaccination. Data can be captured while being offline and uploaded to the server when
connectivity is present. Enter data based on the disaggregation available in the tool (Vaccine type, Age, Sex, Organization,
Period). Make sure data is entered to the appropriate category

Event Report: - With the Event Report app in the DHIS2, you can analyse events in two types of reports:

• Aggregated event reports: Pivot table-style analysis with aggregated numbers of events
By selecting Aggregated values from the top-left menu you can use the Event Reports app to create pivot
tables with aggregated numbers of events. An event report is always based on a program. You can do analysis
based on a range of dimensions. Each dimension can have a corresponding filter. Dimensions can be selected
from the left-side menu.
• Individual event reports: Lists of events
By selecting Events from the top-left menu you can use the Event Reports app to make searches or queries for
events based on a flexible set of criteria. The report will be displayed as a table with one row per event. Each
dimension can be used as a column in the table or as a filter. Each dimension can have a criterion (filter). Data
elements of type option set allows for "in" criteria, where multiple options can be selected. Numeric values can
be compared to filter values using greater than, equal or less than operators.

Event Visualizer: - With the Event Visualizer app, you can create charts based on event data.

Pivot Table: - With the Pivot Table app, you can create pivot tables based on all available data dimensions in DHIS2. A
pivot table is a dynamic tool for data analysis which lets you summarize and arrange data according to its dimensions.

COVID-19 Data Management SOP

Examples of data dimensions in DHIS2 are:

• data dimension itself (for example data elements, indicators, and events)
• periods (representing the time period for the data)
• organisation hierarchy (representing the geographical location of the data)

From these dimensions you can freely select dimension items to include in the pivot table. You can create additional
dimensions in DHIS2 with the group set functionality. This allows for different aggregation pathways, such as aggregation
by facility type.

A pivot table can arrange data dimensions on columns, rows, and as filters. When you place a data dimension on columns,
the pivot table will display one column per dimension item. If you place multiple data dimensions on columns, the pivot
table displays one column for all combinations of the items in the selected dimensions. When you place a data dimension on
rows, the pivot table displays one row per dimension item in a similar fashion. The dimensions you select as filters will not
be included in the pivot table but will aggregate and filter the table data based on the selected filter items.

Dashboard: - The Dashboards app makes it possible to present a high-level overview of your data, including displaying
analytical objects such as maps, charts, reports and tables, as well as displaying text-based information, resource links, and
app widgets.

To create a new dashboard, click the + button in the left corner of the dashboards bar to enter create/edit mode:

In create/edit mode, you can add or change the dashboard title, description, and dashboard items. If you do not add a title, the
dashboard will automatically be titled "Untitled dashboard"

Add items to the dashboard by searching for items using the Search for items to add to this dashboard drop down selector.
Item types are:

• Visualizations (charts and tables)

• Maps
• Event reports
• Event charts
• Reports

COVID-19 Data Management SOP

 6. Monitoring Vaccination Coverages

The following indicators measure progress with vaccination among a target population:

Vaccine uptake or vaccination rate: the number of people vaccinated with a certain dose of the vaccine in a
certain time (e.g., during a month or year), which can be expressed as an absolute number or as the proportion of a target
population.

Vaccination coverage: the vaccinated proportion of a target population. Coverage can be estimated by accounting
for vaccination in previous time periods (weeks, months, years).

The difference between these two concepts is that uptake expresses vaccination activity over time, while coverage expresses
the resulting protection among a population. Uptake and coverage should be tracked by dose and can be annotated as
follows:

First Dose Coverage (COV-1): - The number of people receiving a first dose of the vaccine, or the proportion of a
target group that did so.

Second Dose Coverage (COV-2): - The number or proportion of people receiving a second dose of the vaccine

Fully Vaccinated Coverage: - The number of people completed the recommended vaccination series. It represents
the number of people who received a last recommended dose of any vaccine.

Booster Coverage: - The number or proportion of people receiving booster doses if relevant for future recommended
vaccination schedules.

Disaggregated monitoring

Vaccine uptake and coverage can be evaluated by dose for the entire population to show headline progress, but more
granular data will be needed to measure vaccination by product and targeted population group.

Disaggregated monitoring by vaccine product is required where several vaccine products are used, especially if different
numbers of doses are required. Furthermore, to measure whether prioritization policies are effectively implemented, and
vaccines are equitably distributed, additional dimensions of disaggregation are needed.

The recommended dimensions for disaggregating vaccine uptake and coverage are: -

Dimension Recommended Remark

Vaccine By Vaccine Type Calculate uptake and coverage with a
By Dose last recommended dose of different
vaccines used in the country
Geography By Region, Zone, Wereda and PHCU Monitor equitable distribution across
regions in a country
Gender Male and Female disaggregation Monitor Gender Equity

Age Group Age disaggregation Regions can disaggregate further if

12-17 years required
18-64 years
>=65 years
Occupation Among health workers, IDPs, Monitor uptake among health workers
Refugees, and other prioritized groups
Pre-existing condition Among people with at least one pre- Monitor uptake among people at risk
existing condition
COVID-19 Data Management SOP
COVID-19 Data Management SOP